This paper aims to review what is known about the preparedness of hospital emergency departments (EDs) for a possible major earthquake expected in the near future in Istanbul and reveal the past experience and future plans from employees' viewpoints and, as well as from the related literature. For this purpose, potential effects of the earthquakes on ED operations, patient flow, and performance are discussed considering the statistical data of recent earthquakes in Turkey, a comprehensive report on the disaster preparedness of Istanbul and, one to one interviews with the earthquake experienced ED medical staff. In particular, issues on patient surge, triage and registration, communication, patient flow and transportation and, lack of enough resources and space to treat are presented as the main challenges. According to the viewpoints obtained from various sources, EDs in Istanbul are not ready to meet the needs caused by a major earthquake. It is proposed that operational research (OR) techniques can be useful to overcome these issues such as simulation modeling.